Pandemic preparedness and responses: WHO to turn to in a crisis?
Journal: PLoS Medicine (2020)

In the thick of a global pandemic, it should be straightforward to appreciate the role and responsibilities of the World Health Organization (WHO).With a newly emerged coronavirus, SARS-CoV-2, exerting an appalling global toll in terms of lives lost, ill-health, and societal and economic disruption, the organization is a fulcrum on which all efforts to combat the COVID-19 outbreak and manage its consequences must be based.As of April 30, in excess of 3.2 million cases had been recorded, with more than 227,000 deaths attributed to the disease [1].WHO Director-General Tedros Adhanom Ghebreyesus, who has led the agency since 2017, has been prominent in the response to the coronavirus outbreak, not least in his authoritative public appearances.Yet the rapidity of the pandemic's growth, and the diverse and apparently tentative responses in certain countries, have created concerns in some quarters about the agency's capabilities to advise on and respond to disease outbreaks.Indeed, on April 14, a short suspension of US funding for WHO was announced, prompted by alleged suppression of information about the COVID-19 outbreak during its early stages in China [2].Little is certain about the course and possible conclusion of the current outbreak, save that the actions and attributes of WHO, its structures, and its people will be scrutinized in the minutest possible detail.WHO is tasked with forcefully representing international resolutions, creating confidence in its unparalleled technical capacity, and acting fairly and responsibly to promote health and wellbeing in all countries, as far as is possible.These countries vary enormously in population size and structure, wealth, political objectives and many other characteristics, of course.Consequently, the element of WHO's 1946 Constitution that posits achievement of "the enjoyment of the highest attainable state of health . . .[by] every human being without distinction" mayperversely given its universal appeal-be subordinated to other, more short-term, factors [3].It is easy to imagine situations in which attaching blame to an international body might be an attractive route to political or economic advantage.WHO's revenue was about $2.9 billion in 2018 [4], made up of assessed and voluntary contributions, the latter category often linked to specific programmes or aims by donors.Large donors and countries are therefore likely to have, or be perceived to have, influence over its actions and announcements.WHO's physical and human footprint is also criticized from time to time, and even ardent supporters would concede that, were the agency to be designed and launched today, its Swiss headquarters, along with 6 regional fiefdoms and 150 country offices, could well be reimagined in a much more streamlined fashion.As we discussed in an Editorial in 2016 [5], WHO's record in previous infectious disease outbreaks has not always met with unqualified approval.The agency's response to the 2012-2014 Ebola outbreak in West Africa, under previous Director-General Margaret Chan, was seen to have been plagued by delay and dysfunction.In the subsequent reports that